U.S. Department of Labor
Employee Benefits Security Administration
The Health Insurance Portability and Accountability Act (HIPAA) offers
protections for millions of American workers that improve portability and
continuity of health insurance coverage.
- Limiting exclusions for preexisting medical conditions (known as
- Providing credit against maximum preexisting condition exclusion
periods for prior health coverage and a process for providing
certificates showing periods of prior coverage to a new group health
plan or health insurance issuer.
- Providing new rights that allow individuals to enroll for health
coverage when they lose other health coverage, get married or add a new
- Prohibiting discrimination in enrollment and in premiums charged to
employees and their dependents based on health status-related factors.
- Guaranteeing availability of health insurance coverage for small
employers and renewability of health insurance coverage for both small
and large employers.
- Preserving the states’ role in regulating health insurance,
including the states’ authority to provide greater protections than
those available under federal law.
- The law defines a preexisting condition as one for
which medical advice, diagnosis, care, or treatment was recommended or
received during the 6-month period prior to an individual’s enrollment
date (which is the earlier of the first day of health coverage or the
first day of any waiting period for coverage).
- Group health plans and issuers may not exclude an
individual’s preexisting medical condition from coverage for more than
12 months (18 months for late enrollees) after an individual’s
- Under HIPAA, a new employer’s plan must give
individuals credit for the length of time they had prior continuous
health coverage, without a break in coverage of 63 days or more, thereby
reducing or eliminating the 12-month exclusion period (18 months for
Includes prior coverage under another group health
plan, an individual health insurance policy, COBRA, Medicaid, Medicare,
CHAMPUS, the Indian Health Service, a state health benefits risk pool,
FEHBP, the Peace Corps Act, or a public health plan.
- Certificates of creditable coverage must be provided
automatically and free of charge by the plan or issuer when an
individual loses coverage under the plan, becomes entitled to elect
COBRA continuation coverage or exhausts COBRA continuation coverage. A
certificate must also be provided free of charge upon request while you
have health coverage or anytime within 24 months after your coverage
- Certificates of creditable coverage should contain
information about the length of time you or your dependents had coverage
as well as the length of any waiting period for coverage that applied to
you or your dependents.
- For plan years beginning on or after
July 1, 2005, certificates of creditable coverage should also include an
educational statement that describes individuals' HIPAA portability
rights. A new model cerfiticate is available on EBSAs Web site.
- If a certificate is not received, or the information on
the certificate is wrong, you should contact your prior plan or issuer.
You have a right to show prior creditable coverage with other evidence
— like pay stubs, explanation of benefits, letters from a doctor —
if you cannot get a certificate.
- Are provided for individuals who lose their coverage in
certain situations, including on separation, divorce, death, termination
of employment and reduction in hours. Special enrollment rights also are
provided if employer contributions toward the other coverage terminates.
- Are provided for employees, their spouses and new
dependents upon marriage, birth, adoption or placement for adoption.
Ensure that individuals are not excluded from coverage,
denied benefits, or charged more for coverage offered by a plan or
issuer, based on health status-related factors.
This fact sheet has been developed by the U.S.
Department of Labor, Employee Benefits Security Administration,
Washington, DC 20210. It will be made available in alternate
formats upon request: Voice phone: 202.693.8664; Text telephone:
202.501.3911. In addition, the information in this fact sheet
constitutes a small entity compliance guide for purposes of the Small
Business Regulatory Enforcement Fairness Act of 1996.